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ASPI malaria project in the keta District of the Volta region of Ghana was sponsored by the national malaria control programme of the Ghana health service under the global fund for HIV/AIDS, Malaria and Tuberculosis
For more than a year, ASPI has partnered with the National Malaria Control Program (NMCP) and Ghana Health Services (GHS) to reduce the prevalence of malaria morbidity and mortality in Ghana’s Keta District. Under sponsorship by the Global Fund, ASPI currently serves more than 23 communities in Keta, specifically targeting pregnant women and children under five who are who are at greatest risk of malaria-specific complications. Program activities and objectives are strategically aligned with the NMCP and PMI Malaria Operational Plan (MOP) and include:
- distribution of insecticide treated nets (ITNs) and promotion of correct and consistent use;
- implementation of bed net re-treatment campaigns and dissemination of supplies;
- promotion of correct use of IPTp among pregnant women;
- training of Community Based Agents (CBAs) to disseminate services and education at the community and household level;
- provision of case management and referrals via home-based care, especially for pregnant women and children under five; and
- dissemination of IEC/BCC materials to support appropriate health seeking behaviour and promote early and effective treatment with ACT.
ASPI collaborates with the Keta District Health Directorate (KDHD), the district-level branch of Ghana Health Services, to carry out each activity in a variety of culturally-appropriate venues, including community durbars, local churches and schools, house-to-house visits, credit group meetings, and heavily travelled areas of Keta’s major highway. By delivering services at the community and household level, ASPI is constantly promoting and re-enforcing positive health messaging in a safe and trusted space, ensuring affordable and easy access to malaria prevention services and education. The Malaria Prevention and Treatment Program is outlined in much greater detail below (please see Program Strategy and Technically-Appropriate Interventions), along with strategies for expanding services to reach a greater number of primary beneficiaries.
To date, the malaria prevention program has been very successful, exceeding projected target indicators in both terms and twice warranting invitation by NMCP to renew contracted services. In its pilot phase, ASPI served 8 communities in Keta District over 6 months, during which it trained and managed 16 CBA’s; presented IEC/BCC to 720 community durbar participants; conducted 400 house-to-house visits and 60 follow-up visits to pregnant women on IPTp; and implemented 2 bed net re-treatment sites where 500 nets were successfully re-treated. A KDHD district-wide evaluation indicated that the project significantly contributed to an overall 3.7% decrease in malaria-specific mortality and a 1.7% decline in malaria morbidity in 2006. Based on these findings, NMCP invited ASPI to expand its program to 15 new communities in Keta District during the following 6-month term. Expanded services included training and managing 26 CBA’s; introducing audio-visual broadcasts during community durbars hosting more than 1,670 participants; constructing 2 additional bed net re-treatment sites and retreating 637 nets; conducting 869 house-to-house visits with 226 follow-up visits for pregnant women on IPTp; distributing 300 ITNs; and posting/disseminating over 2,200 malaria control materials.
Success and continued growth of the Malaria Prevention and Treatment Program is made possible through the on-going support of NMCP and KDHD. While ASPI currently partners with several Ghanaian government health agencies, it has met the most success establishing a long-term and constructive relationship with NMCP and KDHD representatives. Not only does ASPI receive project funding, commodities and policy support from NMCP, but it collaborates closely with KDHD in the field to implement services at the community and household level. ASPI and KDHD regularly share resources, such as training curriculum, referrals for qualified CBAs, and surveillance and evaluation data, and leverage each other’s technical skills and support to maximize service delivery. When selecting participant communities, the agencies consult the same strategic work plan so as to avoid duplicating services and target those in greatest need of support. ASPI holds bi-monthly meetings with KDHD representatives to discuss program progress, strategically coordinate upcoming events, and address any challenges in the field. Most importantly, ASPI and KDHD management and staff enjoy a close and congenial working relationship -- Moses O.T. Owharo, Executive Director of ASPI speaks almost daily to Dr. Atsu Seake-Kwawu, District Director of Keta Health Services. Dr. Atsu has kindly provided a letter of recommendation on behalf of ASPI, attached as Appendix A along with recommendations from Ms. Naa Korkor Allotey, NMCP Zonal Coordinator and Togbui Gamor II, Keta District Ayanui Sub-Divisional Chief.
The end-line survey conducted to evaluate the project revealed the following gains in respect of the project objectives.
- Project Objective1: To promote correct and consistent use of ITNs, especially among pregnant women and children under five
As can be observed in Table 1 below, very good gains were achieved for most of the key indicators of the project objectives. ITN ownership among children under five and pregnant women increased from 49.6% to 97.5% and from 43.5% to 97.2%, respectively. Similarly, ITN usage increased from 75.4% to 97.7% and from 76.0% to 91.5% among children under five and pregnant women, respectively.
- Child with fever/malaria taken to health center/hospital within 24 hours 8 to76.8
- Households with any bed net(s) under 5 children 79.3 to 97.8 and pregnant women 69.1 to 98.9
- Use of ACT during episode of fever/ malaria under 5 children 22.7to53.8 pregnant women 30.9 to 46
- Awareness among pregnant women on intermittent preventive treatment (IPT)3 to 98.3